The impact of ‘new-generation’ anti-psychotic medication on criminal justice outcomes

Publication Date10 December 2002
Pages73-96
DOIhttps://doi.org/10.1016/S0192-0812(03)80018-1
AuthorJohn A. Pandiani,Steven M. Banks,Sheila M. Pomeroy
THE IMPACT OF 'NEW-GENERATION'
ANTI-PSYCHOTIC MEDICATION ON
CRIMINAL JUSTICE OUTCOMES
John A. Pandiani, Steven M. Banks and
Sheila M. Pomeroy
ABSTRACT
This chapter reports the results of a study that used anonymous
administrative databases and statistical techniques to determine the
number of people in two databases. Results indicate that fewer adults with
severe and persistent mental illness got into trouble with the law after
beginning new-generation anti-psychotic medication than before. This
impact was not uniformly felt, however. Men experienced
decreased
criminal justice involvement, while criminal justice involvement for
women
increased.
Access to new-generation anti-psychotic medication
was substantially greater for people who had previously been in trouble
with the law and this difference was greater among younger clients.
INTRODUCTION
Criminal justice outcomes for recipients of mental health services have been an
important issue in mental health services research for years. The long term
"deinstitutionalization" of mental health patients which began with the
introduction of anti-psychotic medication in the 1950s has led to increasing
Community-Based Interventions for Criminal Offenders with Severe Mental Illness,
Volume 12, pages 73-96.
Copyright © 2003 by Elsevier Science Ltd.
All rights of reproduction in any form reserved.
ISBN: 0-.7623-0972-5
73
74 JOHN A. PANDIANI, STEVEN M. BANKS AND SHEILA M. POMEROY
concern regarding the potential "criminalization" of mental illness (Torrey et
al., 1992). This concern is based, in part, on the observation that the population
of state mental hospitals in the United States has been steadily decreasing,
while the number of people in correctional facilities has been steadily
increasing (Steadman et al., 1984).
This chapter addresses this important policy issue by examining the impact
of "new-generation" anti-psychotic medications on criminal justice involve-
ment. Specifically, we will report the findings of a statewide study of the
integration of the new-generation anti-psychotic medications (introduced in
the early 1990s) into routine practice in Vermont's statewide community-based
system of care for adults with severe and persistent mental illness. Two basic
questions will be addressed. The issue of treatment outcomes will be examined
by comparing rates of criminal justice involvement before receipt of new-
generation anti-psychotic medication to rates of criminal justice involvement
during receipt of new-generation anti-psychotic medication for people "going
on" new-generation anti-psychotic medication. In addition, rates of criminal
justice involvement for people who received new-generation anti-psychotic
medications will be compared to rates for those who did not. Finally, the issue
of access to care will be examined by comparing rates of utilization of new-
generation anti-psychotic medication for people in different demographic
categories.
Utilization of new-generation anti-psychotic medications has been identified
by the National Association of State Mental Health Program Directors
(NASMHPD), the organization representing the nation's state mental health
agency administrators, as one of the, "evidence-based practices" that should be
implemented by publicly funded community mental health programs. These
new-generation anti-psychotic medications include Clozapine, Risperidone,
Olanzapine, and Quetiapine. NASMHPD's framework includes rates of access
to new-generation anti-psychotic mediation for clients served by state mental
health programs as an important indicator of the performance of systems of
care because, "Organizations that are focused on providing quality services
work to insure that consumers are receiving treatments that are consistent with
defined 'best practices'. At least two sets of guidelines have been developed for
the treatment of psychosis. Both consider new-generation anti-psychotics to be
preferable over older agents. New-generation agents have demonstrated
advantages in efficacy and, with the exception of clozapine, safety over older
agents. Use of the agents may be an indicator of the degree to which consumers
of the organization are receiving treatments that conform to best practices"
(National Association of State Metal Health Programs Directors Research
Institute, 2002). Much of the research endorsing this practice pattern, however,

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